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US5997862A - Therapeutic treatment of group A streptococcal infections - Google Patents

Therapeutic treatment of group A streptococcal infections Download PDF

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Publication number
US5997862A
US5997862A US08/962,523 US96252397A US5997862A US 5997862 A US5997862 A US 5997862A US 96252397 A US96252397 A US 96252397A US 5997862 A US5997862 A US 5997862A
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US
United States
Prior art keywords
composition according
carrier
group
enzyme
streptococcal
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Expired - Fee Related
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US08/962,523
Inventor
Vincent Fischetti
Lawrence Loomis
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NEW HORIZONS DIAGNOSTICS Inc
Rockefeller University
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New Horizons Diagnostics Corp
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Priority to US08/962,523 priority Critical patent/US5997862A/en
Application filed by New Horizons Diagnostics Corp filed Critical New Horizons Diagnostics Corp
Assigned to NEW HORIZONS DIAGNOSTICS, INC. reassignment NEW HORIZONS DIAGNOSTICS, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: FISCHETTI, VINCENT, LOOMIS, LAWRENCE
Priority to US09/257,026 priority patent/US5985271A/en
Priority to US09/257,025 priority patent/US6017528A/en
Priority to US09/395,636 priority patent/US6056954A/en
Application granted granted Critical
Publication of US5997862A publication Critical patent/US5997862A/en
Priority to US09/482,992 priority patent/US6264945B1/en
Priority to US09/497,495 priority patent/US6238661B1/en
Priority to US09/653,690 priority patent/US6254866B1/en
Priority to US09/654,483 priority patent/US6423299B1/en
Priority to US09/654,482 priority patent/US6399097B1/en
Priority to US09/671,878 priority patent/US6432444B1/en
Priority to US09/671,991 priority patent/US6399098B1/en
Priority to US09/671,992 priority patent/US6335012B1/en
Priority to US09/671,879 priority patent/US6248324B1/en
Priority to US09/671,990 priority patent/US6326002B1/en
Priority to US09/671,881 priority patent/US6428784B1/en
Priority to US09/671,882 priority patent/US6277399B1/en
Priority to US09/671,880 priority patent/US6406692B1/en
Priority to US09/846,688 priority patent/US20030113298A1/en
Priority to US09/866,106 priority patent/US6685937B2/en
Priority to US09/932,460 priority patent/US6737079B2/en
Priority to US09/960,472 priority patent/US20020136712A1/en
Priority to US10/012,032 priority patent/US20020094319A1/en
Priority to US10/067,991 priority patent/US7014850B2/en
Priority to US10/067,979 priority patent/US6893635B2/en
Priority to US10/067,995 priority patent/US7141241B2/en
Priority to US10/083,462 priority patent/US20020098234A1/en
Priority to US10/083,142 priority patent/US6733749B2/en
Priority to US10/105,076 priority patent/US6881403B2/en
Priority to US10/104,488 priority patent/US20020119132A1/en
Priority to US10/105,075 priority patent/US20020119133A1/en
Priority to US10/135,824 priority patent/US6875431B2/en
Priority to US10/135,851 priority patent/US6899874B2/en
Priority to US10/135,826 priority patent/US7687069B2/en
Priority to US10/135,825 priority patent/US20020159987A1/en
Priority to US10/145,604 priority patent/US6936244B2/en
Priority to US10/176,375 priority patent/US20030082110A1/en
Priority to US10/219,251 priority patent/US20030129147A1/en
Priority to US10/219,250 priority patent/US20030129146A1/en
Assigned to ROCKEFELLER UNIVERSITY, THE reassignment ROCKEFELLER UNIVERSITY, THE ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: NEW HORIZONS DIAGNOSTICS CORPORATION, FISCHETTI, VINCENT A.
Priority to US10/465,889 priority patent/US7169408B2/en
Priority to US10/720,266 priority patent/US7232576B2/en
Priority to US10/868,195 priority patent/US20070212340A1/en
Priority to US11/186,018 priority patent/US20060292135A1/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N9/00—Enzymes; Proenzymes; Compositions thereof; Processes for preparing, activating, inhibiting, separating or purifying enzymes
    • C12N9/14—Hydrolases (3)
    • C12N9/48—Hydrolases (3) acting on peptide bonds (3.4)
    • C12N9/50—Proteinases, e.g. Endopeptidases (3.4.21-3.4.25)
    • C12N9/503—Proteinases, e.g. Endopeptidases (3.4.21-3.4.25) derived from viruses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
    • A61K38/46—Hydrolases (3)
    • A61K38/47—Hydrolases (3) acting on glycosyl compounds (3.2), e.g. cellulases, lactases
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/04—Antibacterial agents
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Y—ENZYMES
    • C12Y302/00—Hydrolases acting on glycosyl compounds, i.e. glycosylases (3.2)
    • C12Y302/01—Glycosidases, i.e. enzymes hydrolysing O- and S-glycosyl compounds (3.2.1)
    • C12Y302/01017—Lysozyme (3.2.1.17)

Definitions

  • the present invention relates to an oral delivery means, such as a candy, chewing gum, lozenge, troche, tablet, a powder, an aerosol, a liquid or a liquid spray, containing a group C streptococcal phage associated lysin enzyme for the prophylactic and therapeutic treatment of Streptococcal A throat infections, commonly known as strep throat.
  • an oral delivery means such as a candy, chewing gum, lozenge, troche, tablet, a powder, an aerosol, a liquid or a liquid spray, containing a group C streptococcal phage associated lysin enzyme for the prophylactic and therapeutic treatment of Streptococcal A throat infections, commonly known as strep throat.
  • Group A streptococci have been shown to be an important pathogen capable of existing both in a carrier state in an asymptomatic individual and in a symptomatic individual with symptoms of disease ranging from a mild sore throat, tonsillitis, or impetigo. If untreated these streptococcal infections could lead to glomerulonephritis, rheumatic fever and possibly permanent rheumatic heart disease. With the advent of antimicrobial agents, specifically penicillin derived antibiotics, the causative organism can be readily eliminated following the prescribed regimen of appropriate antibiotic therapy.
  • the first individual to identify the serological and immunological groups of streptococci was Dr. Rebecca Lancefield, (Lancefield, R. C., "A Serological Differentiation of Human and other Groups of Hemolytic Streptococci," J. Exp. Med., Vol. 57, pp 571-595 1933), after whom the grouping system was named.
  • the group A streptococcus was identified on the basis of B-1, 4 N-acetylglucosamine terminal sugar moieties on a repeating rhamnose sugar backbone found as part of the structure of the organism's cell wall.
  • Antiserum raised against group A streptococci and subsequent absorptions to remove cross-reactions were shown to specifically react with the cell wall component of these organisms and became the grouping antisera for group A streptococci.
  • a number of methods have been devised to fragment the group A streptococcal cell wall carbohydrate. These methods include heating by boiling at pH 2.0, autoclaving, trichloroacetic acid extraction, hot formamide digestion, nitrous acid extraction and enzyme digestion by enzymes derived from the soil microorganisms of species streptomyces, and the phage-associated enzyme lysin. Each of these methods have various advantages and disadvantages.
  • group A streptococcal pharyngitis has become more readily available to both physicians and clinical laboratories by replacing time consuming culturing methods requiring a minimum of 24 to 72 hours to identify the presence of group A streptococci with a rapid antigen-antibody test capable of being performed and read in less than one hour.
  • Culturing methods vary in the degree of sensitivity of detection.
  • a simple 5% sheep blood agar plate may be used in conjunction with a Bacitracin disc and culturing 24 hours at 37 degree(s) C. aerobically to identify group A streptococci.
  • a selective media and anaerobic conditions may be used to inhibit overgrowth by other organisms and incubation at 35 degree(s) C.
  • the sensitivity of the immunoassay procedure is effected by the amount of group A streptococcal carbohydrate antigen released and recognized by the specific immunological reagent.
  • Enzymatic digestion by enzymes such as that produced by the species streptomyces have proven to be quite effective in antigen release over some chemical methods and micro-nitrous acid but the poor specific activity and the presence of proteases makes it slow and incompatible for prolonged contact with immunological reagents.
  • Maxted, Maxted, W. R., "The Active Agent in Nascent Phage Lysis of Streptococci," J. Gen Micro, vol 16, pp 585-595 1957
  • Krause Krause, (Krause, R.
  • U.S. Pat. No. 5,604,109 teaches the rapid and sensitive detection of group A streptococcal antigens by a diagnostic test kit which utilizes a sampling device consisting of a throat swab made of synthetic or natural fibers such as Dacron or rayon and some type of shaft which holds the fibers and which is long enough to place the fibers in the tonsillar area and capable of being used to swab the area to remove sufficient numbers of colonizing or infecting organisms.
  • the swab can then be placed in the enzyme extraction reagent in several configurations and subsequently used in an immunoassay.
  • the invention can comprise a test kit for detecting Group A streptococci, comprising an extraction reagent containing lysin enzyme for releasing Group A streptococcal components, and a ligand capable of binding with a component of the Group A streptococcus.
  • the present invention uses the lysin enzyme produced by the group C streptococcal organism after being infected with a particular bacteriophage (identified as C1) as either a prophylactic treatment for preventing those who have been exposed to others who have the symptoms of a strep infection from getting sick, or as a therapeutic treatment for those who have already become ill from the infection.
  • the lysin enzyme would be administered in the form of a candy, chewing gum, lozenge, troche, tablet, a powder, an aerosol, a liquid or a liquid spray.
  • the method for the treatment of streptococcus A exposure will comprise applying an effective dosage of a pharmaceutically acceptable amount of an extraction reagent comprising Group C streptococcal phage associated lysin enzyme to the oral mucosa of a mammal in need of treatment, permitting the extraction reagent to remain in contact with the oral mucosa for a period of time necessary for the lysin enzyme to saturate the oral mucosa; and applying additional dosages of such the lysin enzyme in like fashion until treatment is complete.
  • the present invention is based upon the discovery that phage lysin can effectively and efficiently break down the cell wall of Group A Streptococci and the resultant antigenic fragments are reactive with antibodies specific for the Group A Streptococcal carbohydrate.
  • the semipurified enzyme is lacking in proteolytic enzymatic activity and therefore non-destructive to specific antibodies when present during the digestion of the bacterial cell wall.
  • This invention discloses the use of the lysin enzyme produced by the group C streptococcal organism after being infected with a particular bacteriophage (identified as C1) as either a prophylactic treatment for preventing those who have been exposed to others who have the symptoms of a strep infection from getting sick, or as a therapeutic treatment for those who have already become ill from the infection.
  • Means of application include, but are not limited to direct, indirect, carrier and special means or any combination of means.
  • Direction application of the lysin enzyme may be by nasal sprays, nasal drops, nasal ointments, nasal washes, nasal injections, nasal packings, or indirectly through use of throat lozenges, or through use of mouthwashes or gargles, or through the use of ointments applied to the nasal nares, the bridge of the nose, or the face or any combination of these and similar methods of application.
  • the forms in which the lysin enzyme may be administered include but are not limited to lozenges, troches, candies, injectants, chewing gums, tablets, powders, sprays, liquids, ointments, and aerosols.
  • the enzyme Prior to, or at the time the enzyme is put in a carrier system, the enzyme may be in a phosphate buffer environment for maintaining a pH range between about 4.0 and about 8.0, more preferably between about 5.5 and about 7.5 and more preferably at about 6.1.
  • the stabilizing buffer should allow for the optimum activity of the lysin enzyme.
  • the buffer may be a reducing reagent, such as dithiothreitol.
  • the stabilizing agent may also be or include a metal chelating reagent, such as ethylenediaminetetraacetic acid disodium salt, or may also contain a citrate-phosphate buffer.
  • the stabilizing buffer may also contain a bactericidal or bacteriostatic reagent as a preservative, such as a small amount of sodium benzoate.
  • the lozenge into which the lysin enzyme is added may contain any or all of the following ingredients: sugar, corn syrup, a variety of dyes, non-sugar sweeteners, flavorings, and any binders.
  • any gum based products may contain any or all of the following ingredients: acacia, carnauba wax, citric acid, corn starch, food colorings, flavorings, non-sugar sweeteners, gelatin, glucose, glycerin, gum base, shellac, sodium saccharin, sugar, water, white wax, and cellulose and other binders.
  • Lozenges may contain any or all of the following ingredients: sucrose, corn starch, acacia, gum tragacanth, anethole, linseed, oleoresin, mineral oil, and cellulose and other binders.
  • sugar substitutes are used in place of dextrose, sucrose, or other sugars.
  • any of the carriers for the lysin enzyme may be manufactured by conventional means. However, it is preferred that any mouthwash or similar type products not contain alcohol to prevent denaturing of the enzyme. Similarly, when the lysin enzyme is being placed in a cough drop, gum, candy or lozenge during manufacture, such placement should be made prior to the hardening of the lozenge or candy but after the cough drop or candy has cooled somewhat, to avoid heat denaturation of the enzyme.
  • the enzyme may be added to these substances in liquid form or in a lyophilized state, whereupon it will be solubilized when it meets a liquid body.
  • the enzyme may also be in a micelle or liposome.
  • the effective dosage rates of the use of the lysin enzyme will depend in part on whether the lysin will be used therapeutically or prophylactically, the duration of exposure of the recipient to the Streptococci, the size and weight of the patient, etc.
  • the effective dosage comprises an amount which is sufficient to provide an enzyme concentration of between about 0.1 mM and 1 M in the saliva of the mammal being treated, or between about 1 mM and about 300 mM in the saliva of the mammal being treated, or between about 5 mM and about 50 mM in the saliva of the mammal being treated. While this treatment may be used in any mammalian species, the preferred use of this product is for a human.
  • the extraction reagent containing the group C phage lysin enzyme is prepared as follows:
  • Group C streptococcal strain 26RP66 (ATCC #21597) or any other group C streptococcal strain is grown in Todd Hewitt medium at 37 degree(s) C. to an OD of 0.23 at 650 nm in an 18 mm tube.
  • Group C bacteriophage (C1) (ATCC #21597-B1) at a titer of 5 ⁇ 10 sup 6 is added at a ratio of 1 part phage to 4 parts cells. The mixture is allowed to remain at 37 degree(s) C. for 18 min at which time the infected cells are poured over ice cubes to reduce the temperature of the solution to below 15 degree(s) C.
  • the infected cells are then harvested in a refrigerated centrifuge and suspended in 1/300th of the original volume in 0.1M phosphate buffer, pH 6.1 containing 5 ⁇ 10 sup -3 M dithiotreitol and 10 ⁇ g of DNAase.
  • the cells will lyse releasing phage and the lysin enzyme.
  • the enzyme solution is aliquoted and tested for its ability to lyse Group A Streptococci.
  • the number of units/ml in a lot of enzyme is determined to be the reciprocal of the highest dilution of enzyme required to reduce the OD650 of a suspension of group A streptococci at an OD of 0.3 to 0.15 in 15 minutes.
  • 4 ⁇ 10 sup 5 to 4 ⁇ 10 sup 6 units are produced in a single 12 liter batch.
  • the enzyme is diluted in a stabilizing buffer containing the appropriate conditions for stability, maximum enzymatic activity.
  • the preferred embodiment is to use a lyophilized reagent which can be reconstituted with water.
  • the stabilizing buffer can comprise a reducing reagent, which can be dithiothreitol in a concentration from 0.001M to 1.0M, preferably 0.005M.
  • the stabilizing buffer can comprise a metal chelating reagent, which can be ethylenediaminetetraacetic acid disodium salt in a concentration from 0.00001M to 1.0M, preferably 0.005M.
  • the stabilizing buffer can comprise a citrate-phosphate buffer in a concentration from 0.001M to 1.0M, preferably 0.05M.
  • the stabilizing buffer can have a pH value in the range of from about 4.0 to 8.0, preferably 6.1.
  • the stabilizing buffer can comprise a bactericidal or bacteriostatic reagent as a preservative. Such preservative can be sodium azide in a concentration from 0.001 percent to 0.1 percent, preferably 0.02 percent.
  • the preparation of phage stocks for lysin production is the same procedure described above for the infection of phage and group C streptococcus in the preparation of the lysin enzyme. However, instead of pouring the infected cells over ice, the incubation at 37 degree(s) C. is continued for a total of 1 hour to allow lysis and release of the phage and also enzyme in the total volume. In order for the phage to be used for subsequent lysin production the residual enzyme must be inactivated or removed to prevent lysis from without of the group C cells rather than phage infection.
  • the enzyme prepared according to example 1 is diluted to a concentration of 100 units/ml in a buffer consisting of 0.05M citrate phosphate buffer pH 6.1 containing 0.1% rabbit immunoglobulin, 0.005M (ethylenedinitrilo) tetraacetic acid disodium salt (EDTA), 0.005M Dithiothreitol, 0.02% sodium azide, 0.01% N-acetylglucosamine.
  • a buffer consisting of 0.05M citrate phosphate buffer pH 6.1 containing 0.1% rabbit immunoglobulin, 0.005M (ethylenedinitrilo) tetraacetic acid disodium salt (EDTA), 0.005M Dithiothreitol, 0.02% sodium azide, 0.01% N-acetylglucosamine.
  • This lyophilized reagent is stable at elevated temperatures (i.e. 45 degree(s) C.) for short term conditions (i.e. 2 weeks) and long term storage at room temperatures (>1 year).
  • mice received 60 ⁇ l of "control” solution divided equally orally and intranasally.
  • mice received 60 ⁇ l of lysin and bacteria mixture divided equally orally and intranasally.
  • Throat swabs were performed onto 5% sheep blood, proteose peptone agar plates containing 500 ⁇ g/ml of streptomycin. Plates were incubated overnight at 37° C.
  • Each dose is kept in contact with the oral mucosa as long as necessary in order to improve performance over the original invention.
  • Improved administration of the lysin enzyme to the oral mucosa may be by any means such as gargles, mouth rinses, lozenges, troches, chewing gums, candies, powders, and sprays, so long as it offers convenience, palatability, safety, or further reduction in the duration of or prevention of the effects of Streptococcus A exposure.

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Abstract

The present invention relates to an oral delivery system containing a group c streptococcal phage associated lysin enzyme for the prophylactic and therapeutic treatment of Streptococcal A throat infections, commonly known as strep throat.

Description

BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to an oral delivery means, such as a candy, chewing gum, lozenge, troche, tablet, a powder, an aerosol, a liquid or a liquid spray, containing a group C streptococcal phage associated lysin enzyme for the prophylactic and therapeutic treatment of Streptococcal A throat infections, commonly known as strep throat.
2. Description of the Prior Art
Group A streptococci have been shown to be an important pathogen capable of existing both in a carrier state in an asymptomatic individual and in a symptomatic individual with symptoms of disease ranging from a mild sore throat, tonsillitis, or impetigo. If untreated these streptococcal infections could lead to glomerulonephritis, rheumatic fever and possibly permanent rheumatic heart disease. With the advent of antimicrobial agents, specifically penicillin derived antibiotics, the causative organism can be readily eliminated following the prescribed regimen of appropriate antibiotic therapy.
The fact that an infected individual (usually children & young adults) can pass group A streptococcal organisms to others, particularly in daycare centers and schools, necessitates the isolation of the known infected individual away from these environments for at least 24 to 72 hours after antimicrobial therapy has been initiated. It has been shown in controlled studies that early detection and appropriate treatment results in a reduction in the overall pattern of cyclic transmission of the troublesome pathogen as well as a reduction or elimination of the sequelae of group A infections (rheumatic fever or nephritis).
The first individual to identify the serological and immunological groups of streptococci was Dr. Rebecca Lancefield, (Lancefield, R. C., "A Serological Differentiation of Human and other Groups of Hemolytic Streptococci," J. Exp. Med., Vol. 57, pp 571-595 1933), after whom the grouping system was named. The group A streptococcus was identified on the basis of B-1, 4 N-acetylglucosamine terminal sugar moieties on a repeating rhamnose sugar backbone found as part of the structure of the organism's cell wall. Antiserum raised against group A streptococci and subsequent absorptions to remove cross-reactions were shown to specifically react with the cell wall component of these organisms and became the grouping antisera for group A streptococci. A number of methods have been devised to fragment the group A streptococcal cell wall carbohydrate. These methods include heating by boiling at pH 2.0, autoclaving, trichloroacetic acid extraction, hot formamide digestion, nitrous acid extraction and enzyme digestion by enzymes derived from the soil microorganisms of species streptomyces, and the phage-associated enzyme lysin. Each of these methods have various advantages and disadvantages.
The rapid diagnosis of group A streptococcal pharyngitis has become more readily available to both physicians and clinical laboratories by replacing time consuming culturing methods requiring a minimum of 24 to 72 hours to identify the presence of group A streptococci with a rapid antigen-antibody test capable of being performed and read in less than one hour. Culturing methods vary in the degree of sensitivity of detection. In one case, a simple 5% sheep blood agar plate may be used in conjunction with a Bacitracin disc and culturing 24 hours at 37 degree(s) C. aerobically to identify group A streptococci. Alternatively, a selective media and anaerobic conditions may be used to inhibit overgrowth by other organisms and incubation at 35 degree(s) C. for a minimum of 48 hours. In addition, depending on the transport media, the delay in testing, and any antibacterial agents that the patient may have taken, culturing may result in nonviable organisms that fail to grow in the media although the patient is indeed colonized by the group A streptococcus. In the latter case a sensitive immunoassay for group A streptococcal antigen can detect these nonviable organisms.
The sensitivity of the immunoassay procedure is effected by the amount of group A streptococcal carbohydrate antigen released and recognized by the specific immunological reagent. Enzymatic digestion by enzymes such as that produced by the species streptomyces, have proven to be quite effective in antigen release over some chemical methods and micro-nitrous acid but the poor specific activity and the presence of proteases makes it slow and incompatible for prolonged contact with immunological reagents. Maxted, (Maxted, W. R., "The Active Agent in Nascent Phage Lysis of Streptococci," J. Gen Micro, vol 16, pp 585-595 1957), Krause, (Krause, R. M., "Studies on the Bacteriophages of Hemolytic Streptococci," J. Exp Med, vol 108, pp 803-821 1958), and Fischetti, (Fischetti, V. A., et al, "Purification and Physical Properties of Group C Streptococcal Phage Associated Lysin," J. Exp Med, Vol 133 pp 1105-1117 1971, have reported the characteristics of an enzyme produced by the group C streptococcal organism after being infected with a particular bacteriophage identified as C1. The enzyme was given the name lysin and was found to specifically cleave the cell wall of group A, group C and group E streptococci. These investigators provided information on the characteristics and activities of this enzyme with regards to lysing the group A streptococci and releasing the cell wall carbohydrate. They never reported on the utility of this enzyme in an immunological diagnostic test for the detection of group A streptococci from throat swabs in patients. The failure to use this enzyme for a clinical diagnostic test was due to a number of problems associated with the enzyme such as: the difficulty in growing large amounts of bacteriophage in the group C streptococci, the time delays in inactivating the residual enzyme when trying to obtain phage stocks, the instability of the enzyme itself to oxidative conditions and heat, and nonspecific reactions in immunoassays performed in the presence of other organisms and the biological components in the sample.
U.S. Pat. No. 5,604,109 (Fischetti et al.) teaches the rapid and sensitive detection of group A streptococcal antigens by a diagnostic test kit which utilizes a sampling device consisting of a throat swab made of synthetic or natural fibers such as Dacron or rayon and some type of shaft which holds the fibers and which is long enough to place the fibers in the tonsillar area and capable of being used to swab the area to remove sufficient numbers of colonizing or infecting organisms. The swab can then be placed in the enzyme extraction reagent in several configurations and subsequently used in an immunoassay. The invention can comprise a test kit for detecting Group A streptococci, comprising an extraction reagent containing lysin enzyme for releasing Group A streptococcal components, and a ligand capable of binding with a component of the Group A streptococcus.
SUMMARY OF THE INVENTION
The present invention (which incorporates U.S. Pat. No. 5,604,109 in its entirety by reference) uses the lysin enzyme produced by the group C streptococcal organism after being infected with a particular bacteriophage (identified as C1) as either a prophylactic treatment for preventing those who have been exposed to others who have the symptoms of a strep infection from getting sick, or as a therapeutic treatment for those who have already become ill from the infection.
The lysin enzyme would be administered in the form of a candy, chewing gum, lozenge, troche, tablet, a powder, an aerosol, a liquid or a liquid spray.
The method for the treatment of streptococcus A exposure will comprise applying an effective dosage of a pharmaceutically acceptable amount of an extraction reagent comprising Group C streptococcal phage associated lysin enzyme to the oral mucosa of a mammal in need of treatment, permitting the extraction reagent to remain in contact with the oral mucosa for a period of time necessary for the lysin enzyme to saturate the oral mucosa; and applying additional dosages of such the lysin enzyme in like fashion until treatment is complete.
The present invention is based upon the discovery that phage lysin can effectively and efficiently break down the cell wall of Group A Streptococci and the resultant antigenic fragments are reactive with antibodies specific for the Group A Streptococcal carbohydrate. The semipurified enzyme is lacking in proteolytic enzymatic activity and therefore non-destructive to specific antibodies when present during the digestion of the bacterial cell wall.
DETAILED DESCRIPTION OF THE INVENTION
This invention discloses the use of the lysin enzyme produced by the group C streptococcal organism after being infected with a particular bacteriophage (identified as C1) as either a prophylactic treatment for preventing those who have been exposed to others who have the symptoms of a strep infection from getting sick, or as a therapeutic treatment for those who have already become ill from the infection.
Means of application include, but are not limited to direct, indirect, carrier and special means or any combination of means. Direction application of the lysin enzyme may be by nasal sprays, nasal drops, nasal ointments, nasal washes, nasal injections, nasal packings, or indirectly through use of throat lozenges, or through use of mouthwashes or gargles, or through the use of ointments applied to the nasal nares, the bridge of the nose, or the face or any combination of these and similar methods of application. The forms in which the lysin enzyme may be administered include but are not limited to lozenges, troches, candies, injectants, chewing gums, tablets, powders, sprays, liquids, ointments, and aerosols.
Prior to, or at the time the enzyme is put in a carrier system, the enzyme may be in a phosphate buffer environment for maintaining a pH range between about 4.0 and about 8.0, more preferably between about 5.5 and about 7.5 and more preferably at about 6.1.
The stabilizing buffer should allow for the optimum activity of the lysin enzyme. The buffer may be a reducing reagent, such as dithiothreitol. The stabilizing agent may also be or include a metal chelating reagent, such as ethylenediaminetetraacetic acid disodium salt, or may also contain a citrate-phosphate buffer.
To prevent spoilage, the stabilizing buffer may also contain a bactericidal or bacteriostatic reagent as a preservative, such as a small amount of sodium benzoate.
The lozenge into which the lysin enzyme is added may contain any or all of the following ingredients: sugar, corn syrup, a variety of dyes, non-sugar sweeteners, flavorings, and any binders. Similarly, any gum based products may contain any or all of the following ingredients: acacia, carnauba wax, citric acid, corn starch, food colorings, flavorings, non-sugar sweeteners, gelatin, glucose, glycerin, gum base, shellac, sodium saccharin, sugar, water, white wax, and cellulose and other binders.
Lozenges may contain any or all of the following ingredients: sucrose, corn starch, acacia, gum tragacanth, anethole, linseed, oleoresin, mineral oil, and cellulose and other binders. In another embodiment of the invention, sugar substitutes are used in place of dextrose, sucrose, or other sugars.
Any of the carriers for the lysin enzyme may be manufactured by conventional means. However, it is preferred that any mouthwash or similar type products not contain alcohol to prevent denaturing of the enzyme. Similarly, when the lysin enzyme is being placed in a cough drop, gum, candy or lozenge during manufacture, such placement should be made prior to the hardening of the lozenge or candy but after the cough drop or candy has cooled somewhat, to avoid heat denaturation of the enzyme.
The enzyme may be added to these substances in liquid form or in a lyophilized state, whereupon it will be solubilized when it meets a liquid body. The enzyme may also be in a micelle or liposome.
The effective dosage rates of the use of the lysin enzyme will depend in part on whether the lysin will be used therapeutically or prophylactically, the duration of exposure of the recipient to the Streptococci, the size and weight of the patient, etc. The effective dosage comprises an amount which is sufficient to provide an enzyme concentration of between about 0.1 mM and 1 M in the saliva of the mammal being treated, or between about 1 mM and about 300 mM in the saliva of the mammal being treated, or between about 5 mM and about 50 mM in the saliva of the mammal being treated. While this treatment may be used in any mammalian species, the preferred use of this product is for a human.
EXAMPLE 1
The extraction reagent containing the group C phage lysin enzyme is prepared as follows:
Group C streptococcal strain 26RP66 (ATCC #21597) or any other group C streptococcal strain is grown in Todd Hewitt medium at 37 degree(s) C. to an OD of 0.23 at 650 nm in an 18 mm tube. Group C bacteriophage (C1) (ATCC #21597-B1) at a titer of 5×10 sup 6 is added at a ratio of 1 part phage to 4 parts cells. The mixture is allowed to remain at 37 degree(s) C. for 18 min at which time the infected cells are poured over ice cubes to reduce the temperature of the solution to below 15 degree(s) C. The infected cells are then harvested in a refrigerated centrifuge and suspended in 1/300th of the original volume in 0.1M phosphate buffer, pH 6.1 containing 5×10 sup -3 M dithiotreitol and 10 μg of DNAase. The cells will lyse releasing phage and the lysin enzyme. After centrifugation at 100,000×g for 5 hrs to remove most of the cell debris and phage, the enzyme solution is aliquoted and tested for its ability to lyse Group A Streptococci.
The number of units/ml in a lot of enzyme is determined to be the reciprocal of the highest dilution of enzyme required to reduce the OD650 of a suspension of group A streptococci at an OD of 0.3 to 0.15 in 15 minutes. In a typical preparation of enzyme 4×10 sup 5 to 4×10 sup 6 units are produced in a single 12 liter batch.
Use of the enzyme requires a minimum number of units of lysin enzyme per test depending on the incubation times required. The enzyme is diluted in a stabilizing buffer containing the appropriate conditions for stability, maximum enzymatic activity. The preferred embodiment is to use a lyophilized reagent which can be reconstituted with water. The stabilizing buffer can comprise a reducing reagent, which can be dithiothreitol in a concentration from 0.001M to 1.0M, preferably 0.005M. The stabilizing buffer can comprise a metal chelating reagent, which can be ethylenediaminetetraacetic acid disodium salt in a concentration from 0.00001M to 1.0M, preferably 0.005M. The stabilizing buffer can comprise a citrate-phosphate buffer in a concentration from 0.001M to 1.0M, preferably 0.05M. The stabilizing buffer can have a pH value in the range of from about 4.0 to 8.0, preferably 6.1. The stabilizing buffer can comprise a bactericidal or bacteriostatic reagent as a preservative. Such preservative can be sodium azide in a concentration from 0.001 percent to 0.1 percent, preferably 0.02 percent.
The preparation of phage stocks for lysin production is the same procedure described above for the infection of phage and group C streptococcus in the preparation of the lysin enzyme. However, instead of pouring the infected cells over ice, the incubation at 37 degree(s) C. is continued for a total of 1 hour to allow lysis and release of the phage and also enzyme in the total volume. In order for the phage to be used for subsequent lysin production the residual enzyme must be inactivated or removed to prevent lysis from without of the group C cells rather than phage infection.
EXAMPLE 2
The enzyme prepared according to example 1 is diluted to a concentration of 100 units/ml in a buffer consisting of 0.05M citrate phosphate buffer pH 6.1 containing 0.1% rabbit immunoglobulin, 0.005M (ethylenedinitrilo) tetraacetic acid disodium salt (EDTA), 0.005M Dithiothreitol, 0.02% sodium azide, 0.01% N-acetylglucosamine. One part colloidal gold sol labelled with Group A Streptococcal Antibody (OD sup 520 1.5) suspended in 0.02M Tris buffer pH 8.2, 1.0% bovine serum albumin, 0.02% sodium azide, 300K units heparin, is added to 3 parts of the enzyme reagent, mixed, filtered through a 0.22 micron filter, and 200 microliters aliquoted per tube and lyophilized. This lyophilized reagent is stable at elevated temperatures (i.e. 45 degree(s) C.) for short term conditions (i.e. 2 weeks) and long term storage at room temperatures (>1 year).
EXAMPLE 3 Method
1. Start a day culture of group A streptococcal strain S43/192/39R (Streptomycin resistant) (from frozen blood broth); 500 μl in 50 ml of Todd Hewitt (TH) broth containing 1% yeast extract and 100 μl of Streptomycin/ml.
2. Grow to an OD650 of 0.59
3. Centrifuge for 15 minutes at 3000 rpm to sediment bacteria.
4. Resuspend organisms in 1 ml volume of TH w/o antibiotics (3×105 /100 μl as determined by plate count).
5. Add 0.5 of these concentrated cells to ) 0.5 ml of pH 6.1 phosphate buffer as a control.
6. Five minutes before administering to the mice, 0.5 ml of the concentrated cell suspension was mixed with 0.5 ml of phage lysin solution pre-diluted to 10,000 units/ml in pH 6.1 phosphate buffer.
Five mice received 60 μl of "control" solution divided equally orally and intranasally.
Five mice received 60 μl of lysin and bacteria mixture divided equally orally and intranasally.
Throat swabs were performed onto 5% sheep blood, proteose peptone agar plates containing 500 μg/ml of streptomycin. Plates were incubated overnight at 37° C.
The following results were obtained:
______________________________________                                    
           Colony Forming Units                                           
           7/22 7/23       7/24   7/28                                    
           1d   2d         3d     7d                                      
______________________________________                                    
LYSIN                                                                     
L1           0      0          0    0                                     
L2           0      0          0    0                                     
L3           0      0          0    0                                     
L4           0      1          0    0                                     
L5           0      0          1    0                                     
CONTROL                                                                   
C1           26     14         7    0                                     
C2           >400   17         100  83                                    
C3           9      0          15   0                                     
C4           >400   >400       >400 220                                   
C5           2      2          30   0                                     
______________________________________
These results show that the contact between phage lysin and group A streptococci for as little as five minutes prevents the streptococci from colonizing the upper respiratory tract of the mice in this model system.
Each dose is kept in contact with the oral mucosa as long as necessary in order to improve performance over the original invention. Improved administration of the lysin enzyme to the oral mucosa may be by any means such as gargles, mouth rinses, lozenges, troches, chewing gums, candies, powders, and sprays, so long as it offers convenience, palatability, safety, or further reduction in the duration of or prevention of the effects of Streptococcus A exposure.
Many modifications and variations of the present invention are possible in light of the above teachings. It is, therefore, to be understood within the scope of the appended claims the invention may be protected otherwise than as specifically described.

Claims (26)

What is claimed is:
1. A pharmaceutical composition for use in the treatment of a streptococcal infection, comprising:
an effective amount of lysin enzyme produced by group C streptococcal bacteria infected with a C1 bacteriophage; and
a carrier for delivering said lysin enzyme to a mouth, throat, or nasal passage.
2. The composition according to claim 1, wherein said carrier is selected from the group consisting of candy, chewing gum, lozenge, troche, tablet, powder, aerosol, liquid, liquid spray, nasal sprays and nasal ointments.
3. The composition according to claim 1, further comprising a buffer that maintains pH of the composition at a range between about 4.0 and 9.0.
4. The composition according to claim 3, wherein said buffer maintains the pH of the composition at range between 5.5 and 7.5.
5. The composition according to claim 3, wherein said buffer comprises a reducing agent.
6. The composition according to claim 5, wherein said reducing agent is dithiothreitol.
7. The composition according to claim 3, wherein said buffer comprises a metal chelating agent.
8. The composition according to claim 7, wherein said metal chelating agent is ethylenediaminetetraacetic disodium salt.
9. The composition according to claim 3, wherein said buffer is a citrate-phosphate buffer.
10. The composition according to claim 1, further comprising a bactericidal or bacteriostatic agent as a preservative.
11. The composition according to claim 1, wherein said lysine enzyme is lyophilized.
12. The composition according to claim 1, wherein said carrier further comprises a sweetener.
13. The composition according to claim 1, wherein said composition is used in the therapeutic treatment of streptococcal infections.
14. The composition according to claim 1, wherein said composition is used in the prophylactic treatment of streptococcal infections.
15. The composition according to claim 14, wherein said streptococcal infection is a streptococcal throat infection.
16. The composition according to claim 1, wherein said carrier is a candy.
17. The composition according to claim 1, wherein said carrier is a chewing gum.
18. The composition according to claim 1, wherein said carrier is a lozenge.
19. The composition according to claim 1, wherein said carrier is a troche.
20. The composition according to claim 1, wherein said carrier is a powder.
21. The composition according to claim 1, wherein said carrier is an aerosol.
22. The composition according to claim 1, wherein said carrier is a liquid spray.
23. The composition according to claim 1, wherein said carrier is a nasal spray.
24. The composition according to claim 1, wherein said mammal is a human.
25. The composition according to claim 1, wherein said carrier is suitable for delivering said lysin enzyme to the mouth and throat.
26. The composition according to claim 1, wherein said carrier is suitable for delivering said lysin enzyme to the nasal passage.
US08/962,523 1997-10-31 1997-10-31 Therapeutic treatment of group A streptococcal infections Expired - Fee Related US5997862A (en)

Priority Applications (42)

Application Number Priority Date Filing Date Title
US08/962,523 US5997862A (en) 1997-10-31 1997-10-31 Therapeutic treatment of group A streptococcal infections
US09/257,026 US5985271A (en) 1997-10-31 1999-02-25 Prophylactic and theraputic treatment of group A streptococcal infection
US09/257,025 US6017528A (en) 1997-10-31 1999-02-25 Therapeutic treatment of group A streptococcal infections
US09/395,636 US6056954A (en) 1997-10-31 1999-09-14 Use of bacterial phage associated lysing enzymers for the prophylactic and therapeutic treatment of various illnesses
US09/482,992 US6264945B1 (en) 1997-10-31 2000-01-14 Parenteral use of bacterial phage associated lysing enzymes for the therapeutic treatment of bacterial infections
US09/497,495 US6238661B1 (en) 1997-10-31 2000-04-18 Use of bacterial phage associated lysing enzymes for treating various illnesses
US09/654,482 US6399097B1 (en) 1997-10-31 2000-09-01 Composition for treatment of a bacterial infection of the digestive tract
US09/653,690 US6254866B1 (en) 1997-10-31 2000-09-01 Use of phage associated lytic enzymes for treating bacterial infections of the digestive tract
US09/654,483 US6423299B1 (en) 1997-10-31 2000-09-01 Composition for treatment of a bacterial infection of an upper respiratory tract
US09/671,880 US6406692B1 (en) 1997-10-31 2000-09-28 Composition for treatment of an ocular bacterial infection
US09/671,878 US6432444B1 (en) 1997-10-31 2000-09-28 Use of bacterial phage associated lysing enzymes for treating dermatological infections
US09/671,882 US6277399B1 (en) 1997-10-31 2000-09-28 Composition incorporating bacterial phage associated lysing enzymes for treating dermatological infections
US09/671,991 US6399098B1 (en) 1997-10-31 2000-09-28 Composition for treating dental caries caused by streptococcus mutans
US09/671,992 US6335012B1 (en) 1997-10-31 2000-09-28 Use of bacterial phage associated lysing enzymes for treating bacterial infections of the mouth and teeth
US09/671,879 US6248324B1 (en) 1997-10-31 2000-09-28 Bacterial phage associated lysing enzymes for treating dermatological infections
US09/671,990 US6326002B1 (en) 1997-10-31 2000-09-28 Use of bacterial phage associated lysing enzymes for treating streptococcal infections of the upper respiratory tract
US09/671,881 US6428784B1 (en) 1997-10-31 2000-09-28 Vaginal suppository for treating group B Streptococcus infection
US09/846,688 US20030113298A1 (en) 1997-10-31 2001-05-02 Use of bacterial phage associated lysing proteins for the prophylactic and therapeutic treatment of various illnesses
US09/866,106 US6685937B2 (en) 1997-10-31 2001-05-25 Chewing gum containing phage associated lytic enzymes for treating streptococcal A infections
US09/932,460 US6737079B2 (en) 1997-10-31 2001-08-20 Bandage composition containing a phage associated lytic enzyme
US09/960,472 US20020136712A1 (en) 1997-10-31 2001-09-21 Bacterial phage associated lysing enzymes for the prophylactic and therapeutic treatment of colonization and infections caused by streptococcus pneumoniae
US10/012,032 US20020094319A1 (en) 1997-10-31 2001-12-11 The use of bacterial phage associated lysing enzymes for treating bacterial infections of the upper respiratory system
US10/067,991 US7014850B2 (en) 1997-10-31 2002-02-08 Nasal spray for treating streptococcal infections
US10/067,995 US7141241B2 (en) 1997-10-31 2002-02-08 Use of bacterial phage associated lysing enzymes for treating upper respiratory illnesses
US10/067,979 US6893635B2 (en) 1997-10-31 2002-02-08 Therapeutic treatment of upper respiratory infections using a nasal spray
US10/083,142 US6733749B2 (en) 1997-10-31 2002-02-27 Throat lozenges for the treatment of Hemosphilus influenza
US10/083,462 US20020098234A1 (en) 1997-10-31 2002-02-27 A Composition for treatment of a bacterial infection of the digestive tract
US10/105,076 US6881403B2 (en) 1997-10-31 2002-03-25 Tampon for the treatment of Streptococcus Group B infections of the vagina
US10/104,488 US20020119132A1 (en) 1997-10-31 2002-03-25 Use of bacterial phage associated lysing enzymes for treating various illnesses
US10/105,075 US20020119133A1 (en) 1997-10-31 2002-03-25 Use of bacterial phage associated lysing enzymes for treating various illnesses
US10/135,824 US6875431B2 (en) 1997-10-31 2002-05-01 Method for the treatment of bacterial eye infections
US10/135,851 US6899874B2 (en) 1997-10-31 2002-05-01 Method for the treatment of bacterial vaginal infections
US10/135,826 US7687069B2 (en) 1997-10-31 2002-05-01 Time release patch containing phage associated lytic enzymes for treating bacterial infections of the skin
US10/135,825 US20020159987A1 (en) 1997-10-31 2002-05-01 Use of phage associated lytic enzymes for treating bacterial infections of the digestive tract
US10/145,604 US6936244B2 (en) 1997-10-31 2002-05-14 Use of bacterial phage associated lysing enzymes for treating streptococcal infections of the upper respiratory tract
US10/176,375 US20030082110A1 (en) 1997-10-31 2002-06-21 Use of bacterial phage associated lysing proteins for treating bacterial dental caries
US10/219,250 US20030129146A1 (en) 1997-10-31 2002-08-16 The use of bacterial phage associated lysing proteins for treating bacterial dental caries
US10/219,251 US20030129147A1 (en) 1997-10-31 2002-08-16 Use of bacterial phage associated lysing proteins for treating bacterial dental caries
US10/465,889 US7169408B2 (en) 1997-10-31 2003-06-20 Bandage composition containing phage associated lytic enzymes useful for treating dermatological infections
US10/720,266 US7232576B2 (en) 1997-10-31 2003-11-25 Throat lozenge for the treatment of Streptococcus Group A
US10/868,195 US20070212340A1 (en) 1997-10-31 2004-06-16 Use of bacterial phage associated lysing enzymes for the prophylactic and therapeutic treatment of various illnesses
US11/186,018 US20060292135A1 (en) 1997-10-31 2005-07-18 Use of bacterial phage-associated lysing proteins for preventing and treating bacterial infections in humans, animals and fowl

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US09/257,025 Continuation-In-Part US6017528A (en) 1997-10-31 1999-02-25 Therapeutic treatment of group A streptococcal infections
US09/395,636 Continuation-In-Part US6056954A (en) 1997-10-31 1999-09-14 Use of bacterial phage associated lysing enzymers for the prophylactic and therapeutic treatment of various illnesses
US09/395,636 Continuation US6056954A (en) 1997-10-31 1999-09-14 Use of bacterial phage associated lysing enzymers for the prophylactic and therapeutic treatment of various illnesses
US09/497,495 Continuation-In-Part US6238661B1 (en) 1997-10-31 2000-04-18 Use of bacterial phage associated lysing enzymes for treating various illnesses
US39563600A Continuation-In-Part 1997-10-31 2000-09-14

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